I went for a routine physical in November and my doctor felt a lump from the DRE (Digital Rectal Examination). A subsequent PSA came back 6.0 ng/ml and the second one 5.5 ng/ml. I was referred to a urologist, but we were unable to schedule a biopsy until February. He took 8 samples, 5 were negative, 2 were suspicious and one had a Gleason 7 (3+4). The urologist assured us that it was very curable and recommend Radical Prostatectomy, but he also sent me to a radiologist. The radiologist recommended External Beam Radiation with a final dose of High Dose Radiation (Brachytherapy).
From all the reading I did, I decided I wanted to explore the da Vinci option(Laparascopic Robotic Radical Prostatectomy). My urologist was glad to refer to me David DiMarco though he felt LRP was too new to be trusted. I liked everything I have been reading about it however. We are fortunate to have just received a generation 2 machine (da Vinci S) at a nearby hospital, only one of 10 in the nation. Dr. DiMarco just completed a fellowship at Mayo using the da Vinci system. He has done 300 of the regular RPs and 20 using da Vinci plus another 50 in which he assisted. His first surgery with this new machine will be next week.
While it would be nice to have someone with more experience, my wife and I were very impressed with his answers to our many questions. His confidence is very contagious. As an experience surgeon with both techniques, he prefers da Vinci and says I am an excellent candidate for it. He did a DRE and agreed that I am T2a. With a Gleason 7, he felt I should not wait too long to do the surgery.
We are ready to take the leap and will likely schedule the surgery for late April.
David DiMarco removed my prostate on April 27 with DaVinci. So far, the results look promising. Reported to the hospital at 6 a.m. on Thursday.
They took me to prep around 7. I declined the offer of a sedative. The prep nurse asked me if I wanted to see the robot. I said sure so walked to the OR where a team of 5 was busy getting ready. I think they were a little surprised to see me. I said that I just wanted to know that they had a live, healthy specimen and I expected to walk out of the hospital the same way I came in! That got a good laugh.
They wheeled me in on the gurney at 7:45. The anesthesiologist decided I was so healthy that he didn't need an artery line (evidently in case they need to deliver a quick stimulus to the heart) so that was good to hear. A few deep breaths in the mask and I was gone. My appendectomy from 1994 gave them a lot of trouble. It took 1-1/2 to get through old adhesions. After that, everything went very well. The surgeon is very confident that they got the whole cancer, but we won't know for sure until the pathology report comes back. We were concerned that he would have to remove one of the nerve bundles on the side of the prostate were the cancer was, but he was able to spare the bulk of it so that is good news. Surgery was done somewhere around 4 I gather. I came to around 4:30.
I managed to sit up but that was about it for Thursday night. I slept well that night. (good drugs!) Friday morning had a short walk and bit of yogurt and a couple bites of banana. Took a shower Friday afternoon, ate dinner and checked out! Not bad for someone who spent 8 hours in surgery the day before. Friday night was a little tough, however. The doc said I could pretty much eat what I wanted, so like a fool, I did. Had baked chicken breast and a couple of cookies for lunch, mashed potatoes and apple pie for dinner. Tasted great! Though I only ate 1/2 of a typical meal, turned out to be way too much. The old bowels were still on strike from the trauma and by midnight, I was as bloated as a blow fish. Things finally got moving later this morning so I'm feeling pretty good now. Other than this dang catheter and a tender side, I almost feel normal.
I go back on Wednesday to get the catheter out and to get my lessons on the exercises and other such things I'll be doing to gain all my normal functions back.
Just returned from the doctor's office where I heard the wonderful words, "This cancer should never bother you again!" The pathology report showed that my cancer was fully contained within the prostate. They also removed my catheter, so on day 6 after surgery, I am now cancer free (most likely), catheter free (most definitely) and almost pain free. Now on to the next stage, regaining control of those other essential bodily functions!
One month update.
I started working half-time in the 3rd week after surgery and full- time the week after that. Physically I feel 100%, though stamina may only be 80 to 90%. Still waiting to see if the insurance is going to pay everything. So far they have covered all but one small charge on the hospital bill after my $2,000 max out of pocket. I was surprised mostly to discover that they do not cover anything for erectile dysfunction, regardless of the cause. Even though most of my nerves were spared, I've not regained much function there yet and 100mg of Viagra does not do much for me. I found a decent vacuum device from "Dr. Cummings" for under $79 that helps somewhat. (Contact me if you want more info.) Next I need to try it with Viagra to see if the combination will do the trick. But I have found that neither are really that necessary for a satisfying experience for both my wife and I. So that really helps to take off some of the pressure to "perform" on demand!
On the other front, I am pleased to report that I am making much better progress with my incontinence. Initially I found that I needed several pads a day. Now I am down to one and even then it is hardly full. Night time is no problem whatsoever. I do have several helpful tips.
First, find the pads made for men! 90% of the pads on the shelf are for women, though they do not say that on the package. Men's pads are wider where you most need it.
Second, no one warned me about urine burn on the tip of your penis. Whenever I feel it, I know that I have not been drinking enough water. Yeast infection on your scrotum comes from the moisture. My wife was quick to diagnosis this. Monistat 7 did wonders to clear it up.
Lastly, do the Kegels! My doctor gave me a good routine, start with 10 quick Kegels, then 10 slow and 10 more quick, rest a bit in between each set. Do this 2x/day. (I do it before I get out of bed and before I go to sleep.) Increase by 5 each week. Being impatient, I started with 20 and am up to 35.
In sum, for those guys who worry about incontinence and impotency, I am pleased to discover that both have turned out to be relatively minor issues for me and I am only one month out so know they will continue to improve with time.
Just back from my 3-month checkup. PSA levels were undetectable as expected. (YEA!) In addition, I stopped wearing pads several weeks ago, but still carry them with me for those times when I am on my feet a lot and begin to leak. Otherwise, I remain completely dry.
My urologist wants me to start doing Kegels 3 times a day (50 short/ 50 long/50 short) so that I can build up the muscle even more and hopefully end all leaking. So now the biggest hurdle is just the ED and there too I am making continual progress. I began using MUSE about 6 weeks ago and it was somewhat helpful, but still not sufficient for intercourse at first. The directions indicated that standing aids in blood flow to the penis and I found that indeed did make a difference. As luck would have it, but the time I put all the pieces together to get a sufficient erection for intercourse, my wife had to have a hysterectomy! She's doing great and we have just another week to go before she gets the green light. In the meantime I discovered that standing also improves the effectiveness of Viagra so I think we will be able to have intercourse without the MUSE, though we may have to be rather creative to get it done. MUSE is not easy to administer, rather disruptive to the whole process and leaves me with a good ache in the penis so I'm hoping to do without. It is also expensive, about $28 per dose. If Viagra alone does not work, I will try the injections. My urologist assures me that it is very effective (biggest problem is using too much causing the erection to last too long).
In sum, I am feeling great, relatively certain that I have been cured and the plumbing is coming along well, though not recovering quite as fast as I had hoped with this surgery. But that really has not been a problem. The only bad news I've received was when the doc told me that for my 6-month checkup he would do a digital exam. I asked why since there is no prostate to feel. He said, "We just want you to feel that you are getting your money's worth!" :-) Evidently a few cancers can return before they show up in the PSA test so he is just being cautious.
I remain a big believer in DaVinci for younger men.
Busy schedules of patient and doctor meant that I did not get in for my six month check-up until my seventh month anniversary. Nothing but good news. My PSA remains undetectable. The digital exam was normal. My incontinence problems have virtually disappeared, just an occasional wetness if I push or lift and forget to squeeze.
The ED has been improving but not fast enough so DiMarco initiated me into using the Tri-mix injection. My wife went with me and was very helpful to the process. The results were absolutely amazing and quick! Easier to administer than MUSE, less painful and faster and better result. So I am now shopping for a good pharmacy to fill my prescription. I remain hopeful that I will regain my natural abilities in time as I see steady though slow improvement and can achieve a reasonable erection after continual stimulation for 20 to 30 minutes. Viagra, Cialis and Levitra all help somewhat, but nothing works as all as the Trim-mix.
First good news: Just returned from my 12 month checkup. After a slight bump in my PSA two months ago (.03), it returned to .01, the lowest possible score that my lab reports. Big relief!
Second good news: The tri-mix was giving me a lot of ache so I switched to bi-mix. It did not produce a very good erection so I started drawing 5 units of tri-mix and then added 20 of bi-mix. That worked very well with no ache. I plan to ask my pharmacy to make me a new batch with that ratio.
Third good news: In March I was able to have intercourse for the first time without any artificial aid. Yea! Since then we have managed to repeat the experience 3 more times. It takes a lot of stimulation, at least 10 to 15 minutes before I can get a decent erection. Viagra helps a little. So I keep the injections handy for those times when nothing seems to help. My wife prefers intercourse without injections as she says I actually get too big when I use the needle.
After the brief scare with the rising PSA, I starting reading up on supplements to lower the risk of cancer. I decided on the following combination: 1 oz pure pomegranate juice (the equivalent of 15 pomegranates) Vitamin C, 500 mg Vitamin E, 400 mg Fish oil, 1000 mg Selenium, 500 mg Lycopene, 15 mg (substitute for tomatoes which I have never liked).
Erectile function is pretty decent. I am able to have intercourse without any aids, just need a lot of stimulation. Viagra gives me a little boost so I do use 50 mg about once a week. Just got some new samples from the doctor and am experimenting with Cialis and Levitra as well.
I still do a routine of 150 kegels every morning before I get out of bed and have very little problems with incontinence.
2 year update
Just returned from my urologist for my two year check-up. My PSA was 0.008, which he tells me is the lowest it ever gets. I fully expected to hear that, but it felt good just the same. (My regular internist had done a PSA check on me a month earlier and told me it was perfect.)
My continence remains good with occasional dribble when I am on my feet for long periods or doing heavy work.
My erectile function has returned to 90% of pre-surgery levels and I have stopped using all aids--the primary difference being the amount of stimulation required to get a decent erection. Still doing Kegels every morning.
In sum, I am a most satisfied customer with the treatment I received and all the outcomes!
Today is the 3rd anniversary of my surgery.
Went to the doctor yesterday for my annual check-up. PSA remains undetectable. Erectile function is good without any aids. Incontinence is very minor (occasional leak, never visible).
The one new development is a small lump on the left side of my penis in the corpora cavernosa. I learned that this is plaque which causes a very slight tilt in that direction and which could indicate the beginning of Peyronie's. So my doctor put me on Vitamin E, 400 units each morning and night.
In sum, I remain very pleased with all the outcomes.
Cleared my 4th annual check up with flying colors! PSA remains null and the doctor didn't even do the usual DRE. (I didn't complain!)
Erectile function remains solid (pun intended!) and still have the minor leak that is never a problem. The small lump remains (Peyronie's) and has not grown. I took vitamin E for 6 months until I finished off the bottle.
So in sum, all remains on course and looking good.
Dan
Cleared the 5 year mark and half way to 6 with everything solid, so to speak! On my last check up my urologist encouraged me to work harder on the Kegel exercises to try and reduce my leakage which is minor and rarely a problem. Still, he thinks I can keep improving so that is the only thing I am working on.
I do find that lubrication can be necessary for successful penetration sometimes. Other than that, I do not use any other aid for sexual activity. The Peyronie's has lessened some what, though the small lump remains.
All else is good and most important, PSA next to nonexistent.
Passed my annual exam with flying colors! PSA remains undetectable, erections remain a pretty solid 8 or 9 (of course the pun is intended!) with no aids or meds and still very minor urine leakage on occasion that is manageable without pads. I am remain a very satisfied customer!
Just had my annual exam, now at 7 years and still null PSA. All else remains good and solid, so to speak! :)
Had my last check up on my 8th anniversary. All remains good with 0 PSA. The doctor also told me that the longer it remains so, the better the odds that the cancer will never return.
My continence remains good. The only time I wear a pad is when I know I will be doing heavy exercising. Erections are excellent without any aid. I find that I can't remain firm for as long as I would like sometimes, but that may be the effect of age (59) as much as anything.
Passed my annual with flying colors and zero PSA. All else remains the same.
No change, cancer free and all functions normal.
No change, which is good news. Going on 12 years, very happy customer!
Mostly the same but they detected a slight uptick in my PSA. The doctor says this could be a by-product of other glands and nothing to worry about yet, but he wants to check again in 6 months to see if there is any change.
Celebrated my 65th and beginning to think about retirement in a few years. Everything still working fine, PSA close to zero. Life is good!
Just had my annual. PSA essentially undetectable again. (Had a slight rise last year but I am convinced it was due to the different way that particular lab does it's testing--every time I have used it they found a very small amount of PSA and then when I go back to the lab with the more sensitive test, they say it is something like 0.014, which is considered as good as nothing.) Turned 65 this year, 14 years after my surgery, and having no erectile problems. Only problem is leakage when doing lots of exercising or going on long walks. I was my surgeon's 5th surgery using DaVinci. He tells me he has now done close to 1000 and that they have made a number of improvements to the machine to make the surgery go even better.
No big change related to my PCa, but I have developed a hydrocele on the right side and I am leaking a bit more than I used to. Not sure if the two are connected. My urologist says there are no known associations of hydroceles and PCa. At the moment, surgery to fix the hydrocele appears to be the only option but he warns recovery can be worse than the surgery I had to remove my prostate. And Medicare may not cover it unless there is a medical reason for the surgery, so basically I have to wait until it becomes so large that there is a medical reason, either that or pay for it myself. I will be talking to the urologist at my annual PSA check in a few weeks.
Only one update, not really related to PCa. I developed a hydrocele in the right testicule which grew to the size of grapefruit before finally having surgery. My same urologist, David DiMarco, did the surgery which was nice since I have been seeing him every year since my prostate surgery and was confident in his abilities. Surgery went well, though the suture burst on the 3rd day - bit of a bloody mess! But otherwise healed nicely and all is back to normal. Otherwise erections are good and just the continued urine leakage whenever I exercise. Easy enough to deal with using pads.
No change, in excellent health.
Dan's e-mail address is: danbryant AT mac.com (replace "AT" with "@")
